The exact cause of Ménière’s disease is not yet known, although it is thought to be caused by a problem with the pressure in the inner ear.

The inner ear is made up of:

• the cochlea – a coiled, spiral tube that contains two fluid-filled chambers and is responsible for hearing
• the vestibular apparatus – a complex set of tubes that help to control balance

The fluid inside the inner ear is called endolymph.

If the pressure of the endolymph fluid changes – for example, because there is too much fluid – it can result in symptoms such as vertigo and tinnitus. It is therefore thought that this pressure change is responsible for Ménière’s disease, although this has not yet been proven.

Increased risk

Although the exact cause of Ménière’s disease is unknown, the following factors may increase the risk developing the condition:

• autoimmunity – when your immune system attacks your own tissues and organs by mistake
• genetic (inherited) factors – for example, if you have a family history of the condition
• a chemical imbalance in the fluid in your inner ear, as a result of too little or too much sodium or potassium in your body
• a problem with the blood vessels – there is a link between Ménière’s disease and migraines, which are thought to be caused by the narrowing and widening of blood vessels
• some viral infections – such as meningitis (an infection of the membranes surrounding the brain and spinal cord)

Vertigo
Vertigo is the sensation that you or the environment around you is moving or spinning.

Tinnitus
Tinnitus is the medical name for the perception of noise in one ear, both ears or in the head. The noise comes from inside the body rather than an outside source.

Allergy
Allergy is the term used to describe an adverse (bad) reaction that the body has to a particular substance.

Immune system
The immune system is the body’s defence system, which helps protect it from disease, bacteria and viruses.

Genetic
Genetic is a term that refers to genes. Genes are the characteristics inherited from a family member.

Blood vessels
Blood vessels are the tubes in which blood travels to and from parts of the body. The three main types of blood vessels are veins, arteries and capillaries.

 

There is no single test for Ménière’s disease and the condition can be difficult to distinguish from other problems because there are several conditions that cause similar symptoms.

For example, migraines and ear infections can also affect your balance and hearing. A viral infection of the balance nerve (vestibular neuronitis) or the inner ear (labyrinthitis) can also produce similar vertigo attacks.

Seeing your GP

You should visit your GP if you experience any of the symptoms of Ménière’s disease.

As Ménière’s disease may only become evident as a pattern of recurring attacks develops over time, your GP will ask you to describe your symptoms to find out if a pattern is emerging.

For Ménière’s disease to be diagnosed, you will need to have the following characteristic symptoms:

• vertigo (a feeling that the environment around you is spinning) – at least two episodes of vertigo lasting 20 minutes or more within a single Ménière’s disease attack
• hearing loss – tests must confirm that hearing loss is caused by damage to the sensitive hair cells inside the cochlea (the coiled tube in the inner ear)
• tinnitus (hearing noises from within your body) or a feeling of pressure in your ear

Your GP may also carry out a general physical examination to rule out other possible causes of your symptoms. This may involve listening to your heartbeat, checking your blood pressure and examining the inside of your ears.

Seeing a specialist

If they think it is necessary, your GP can refer you to a specialist for some further tests.

In most cases, you will probably be referred to an ear nose and throat (ENT) specialist at the ENT department of your local hospital.

You can also be referred to a specialist in audiovestibular medicine for hearing and balance assessment, although this service may not be available in every hospital.

Some of the tests you may have are described below.

Hearing tests

The specialist will be able to assess the extent of your hearing loss using hearing tests, such as:

• an audiometry test – where you listen to sounds of different volume and pitch produced by a machine and you signal when you hear a sound, either by raising your hand or pressing a button
• an otoacoustic emission test – where a computer attached to a small earpiece plays quiet clicking noises and measures the response from your ear

However, if your Ménière’s disease is in the early stage, an audiometry test will not always detect hearing loss because hearing loss at this stage is often only temporary.

Read more about how hearing tests are carried out.

Electronystagmography

Electronystagmography (ENG) may be used to check for signs of uncontrollable eye movements (nystagmus) because this can indicate a problem with the organs that help you balance.

During this test, special goggles are placed over your eyes and you will be asked to look at various still and moving targets.

In some cases, these goggles are fitted with a video camera to record the movements of your eyes. This is known as videonystagmography (VNG).

Caloric testing

A caloric test involves running warm or cool water into your ear for about 30 seconds. The change in temperature stimulates the balance organ in the ear, allowing the specialist to check how well it’s working.

This test is not painful, although it is normal to feel dizzy for a couple of minutes afterwards.

Electrocochleography

Electrocochleography is a test used to measure the activity of your hearing nerves in response to sound.

During this test, a series of electrodes will be attached to your head and a thin probe or needle will then be passed into your ear so that it touches or passes through your eardrum. Local anaesthetic will be used to numb your eardrum before the procedure if a needle is going to be passed through it.

You will then listen to a series of loud clicks, while the activity of your nerves is picked up by the electrodes and probe or needle.

Scans

In some cases, a magnetic resonance imaging (MRI) scan of your head may be carried out to look for any abnormalities in your brain – such as an acoustic neuroma (a non-cancerous tumour) – that could be causing your symptoms.

Vertigo
Vertigo is the sensation that you or the environment around you is moving or spinning.

Tinnitus
Tinnitus is the medical name for the perception of noise in one ear, both ears or in the head. The noise comes from inside the body rather than an outside source.

Ménière’s disease is a rare disorder that affects the inner ear. It can cause vertigo, tinnitus, hearing loss, and a feeling of pressure deep inside the ear.

People with Ménière’s disease usually experience these symptoms during sudden attacks that typically last around two to three hours, although it can take a day or two for the symptoms to disappear completely.

It’s worth noting, however, that the symptoms and severity of Ménière’s disease vary widely from person to person.

You should see your GP if you experience any of the symptoms of Ménière’s disease so they can try to identify the problem and refer you to a specialist if necessary.

Read more about the symptoms of Ménière’s disease and diagnosing Ménière’s disease.

How Ménière’s disease progresses

Ménière’s disease often progresses through different stages. In the early stages, most people have sudden and unpredictable attacks of vertigo, accompanied by nausea, vomiting and dizziness.

During the later stages, the episodes of vertigo tend to occur less frequently and sometimes stop altogether within five to 10 years. However, the tinnitus and hearing loss often become worse over time and you may be left with permanent balance problems.

Who is affected

In the UK, it’s estimated that around one in 1,000 people have Ménière’s disease.

Ménière’s disease most commonly affects people aged 20-60 and it is thought to be slightly more common in women than men.

What causes Ménière’s disease?

The exact cause of Ménière’s disease is unknown, but it is thought to be caused by a problem with the pressure deep inside the ear.

Things that can increase your risk of developing Ménière’s disease include a family history of the condition and a chemical imbalance in the fluid in your inner ear.

Read more about the causes of Ménière’s disease.

How Ménière’s disease is treated

There is not yet an absolute cure for Ménière’s disease, but treatments can usually help people with the condition control their symptoms.

Possible treatments include:

• medications to treat the symptoms and prevent attacks
• changes to your diet, such as a low-salt diet
• balance training (vestibular rehabilitation)
• relaxation techniques
• surgery, in more severe cases

There are a number of different surgical procedures that may be used to treat people with Ménière’s disease, depending on how troublesome your symptoms are and whether only one or both ears are affected. However, there is still uncertainty about the effectiveness of some surgical treatments, and research is continuing in these areas.

Read more about the treatment of Ménière’s disease.

Support and advice

People with Ménière’s disease may also find the condition has a significant impact on their mental health. The unpredictable nature of the attacks and the restrictions this can place on your activities can lead to feelings of anxiety and depression.

Your GP can offer advice and support if you are finding it difficult to cope with the effect Ménière’s disease is having on your life. There are also a number of support groups, such as the Meniere’s Society, that can provide assistance and advice.

Read more about living with Ménière’s disease.

Vertigo
Vertigo is the sensation that you or the environment around you is moving or spinning.

Tinnitus
Tinnitus is the medical name for the perception of noise in one ear, both ears or in the head. The noise comes from inside the body rather than an outside source.

Living with Ménière’s disease can be difficult and frustrating as your balance and hearing may be significantly impaired during an attack, meaning certain activities can be dangerous.

The unpredictable nature of the condition means you may need to change your daily activities so you do not place yourself, or others, in danger. Situations that you may need to avoid include:

• swimming
• climbing ladders or scaffolding
• operating heavy machinery
• driving (see below)

You may also need to try to make sure someone is with you most of the time in case you need help during an attack.

These restrictions may leave you feeling stressed, anxious, or depressed. You should speak to your GP if you are finding it difficult to come to terms with the effect Ménière’s disease is having on your life. They will be able to offer advice and support.

Support groups and charities

There are also several support groups and charities that can provide you with useful information and advice about living with Ménière’s disease. They can also put you in touch with other people who have the condition so you can share experiences and provide support to one another.

The UK Ménière’s Society offers a range of resources and information for people with Ménière’s disease and for those who care for them.

As the symptoms of Ménière’s disease can affect your work and family life, you may need advice on financial and relationship issues. The Citizens Advice Bureau and GOV.UK may be useful.

If you are caring for someone with Ménière’s disease, you can find relevant information, advice and help by visiting care and support.

Driving

If you experience sudden episodes of vertigo and dizziness, you must inform the Driver and Vehicle Licensing Agency (DVLA) about your condition before driving.

You will need to fill in a form about your condition and the DVLA will ask for permission to obtain reports on your condition from your doctor or specialist.

Your case will be assessed on an individual basis, but it is likely you will not be allowed to continue driving if you experience sudden attacks of vertigo and dizziness that are not preceded by any warning signs.

Driving will not be permitted again until you have satisfactory control of your symptoms, in which case you will need to reapply for a licence. Your GP or ear, nose and throat (ENT) specialist will have to confirm that your symptoms have improved and are under control.

If you drive a heavy goods vehicle or a passenger-carrying vehicle and you are diagnosed with Ménière’s disease, you usually have to be symptom-free for a year before you can reapply for a licence.

Visit GOV.UK for more information about driving with a disability or health condition.

The symptoms of Ménière’s disease vary from person to person. Initially, they tend to occur as sudden attacks that last a few hours.

You should see your GP if you experience any of the symptoms of Ménière’s disease so they can try to identify the problem and refer you to a specialist if necessary.

Main symptoms

The main symptoms of Ménière’s disease are:

• vertigo – the sensation that you, or the environment around you, is moving or spinning
• tinnitus – hearing sounds from inside your body, rather than from an outside source
• hearing loss, with a particular difficulty hearing deep or low sounds
• a sense of pressure or fullness deep inside the ear

These symptoms usually only affect one ear at first, but both ears often become affected over time.

Vertigo and tinnitus are described in more detail below.

Vertigo

Vertigo is one of the most common and noticeable symptoms of Ménière’s disease. 

As well as a sensation of spinning, you may also experience additional symptoms during an attack of vertigo, such as dizziness, feeling sick and problems with balance. You may have difficulty standing or walking. Occasionally, you may have ‘drop attacks’, where you suddenly fall to the ground.

During a severe attack, you may also experience sweating, diarrhoea and palpitations (rapid or irregular heartbeats).

Tinnitus

Tinnitus is usually more noticeable when you are tired or when it is quiet, as there is less background noise to distract you from the sounds that come from inside your body.

Examples of sounds you may hear include buzzing, humming, grinding, hissing and whistling.

Stages of Ménière’s disease

Ménière’s disease is often divided into early, middle and late stages.

However, the progression of Ménière’s disease varies between individuals and you may not necessarily pass through each of these stages. In general, people experience more attacks during the first few years, and then as the attacks decrease in frequency over time, the hearing loss becomes progressively worse.

The stages of Ménière’s disease are described in more detail below.

Early stage

The early stage of Ménière’s disease consists of sudden and unpredictable attacks of vertigo. These are usually accompanied by nausea, vomiting and dizziness. You may lose some hearing during the attack, and there is often tinnitus at the same time. Your ear may also feel blocked and uncomfortable, with a sense of fullness.

Attacks of vertigo at this stage can last from 20 minutes to 24 hours, but usually last around two to three hours. Your hearing and the full sensation in your ear will usually return to normal between attacks.

Middle stage

The middle stage of Ménière’s disease consists of continuing attacks of vertigo, with the attacks becoming less severe. However, tinnitus and hearing loss often become worse.

During the middle stage, you may experience some periods of remission (where your symptoms go away), which can last for up to several months.

Late stage

During the late stage of Ménière’s disease, the episodes of vertigo occur far less frequently and may stop altogether. However, you may be left with balance problems, and you may be unsteady on your feet, particularly in the dark.

Hearing problems and tinnitus tend to become progressively worse during the late stage of Ménière’s disease.  

Vertigo
Vertigo is the sensation that you or the environment around you is moving or spinning.

Tinnitus
Tinnitus is the medical name for the perception of noise in one ear, both ears or in the head. The noise comes from inside the brain rather than an outside source.

There is not yet an absolute cure for Ménière’s disease, but treatments can usually help people with the condition control their symptoms.

Your ear, nose and throat (ENT) specialist and your GP will be able to help you manage your symptoms using a variety of techniques. Possible treatments include:

• dietary advice, particularly a low-salt diet
• medication to treat and prevent attacks
• treatment for tinnitus 
• treatment for hearing loss 
• treatment called vestibular rehabilitation to cope with balance problems
• treatment for stress, anxiety and depression
• surgery

Your GP and ENT specialist will provide you with advice and information tailored to your individual needs, and will develop a management plan to enable you to cope more effectively with your symptoms.

In some cases, the treatment available may depend on what your local NHS Clinical Commissioning Group (CCG) can provide.

Treatment during an attack

During an attack of Ménière’s disease, you may be prescribed medication for seven to 14 days to treat the symptoms of vertigo, nausea and vomiting.

The medications usually prescribed are prochlorperazine or an antihistamine. If these medicines are successful in treating your symptoms, you may be given a supply to keep close at hand so you can take them quickly during an attack.

Prochlorperazine

Prochlorperazine can cause side effects including tremors (shaking) and involuntary body or facial movements. It can also make some people feel sleepy.

Check the patient information leaflet that comes with your medicine for the full list of possible side effects, or read more about prochlorperazine.

If you experience vomiting during your attacks, you can take a type of prochlorperazine called Buccastem. This comes as a tablet that you place between your gums and your cheek on the inside of your mouth. The tablet dissolves and is absorbed into your body.

Antihistamines

Antihistamines you may be prescribed include cinnarizine, cyclizine and promethazine teoclate.

Antihistamines can make you feel sleepy. Headaches and an upset stomach are also possible side effects. Check the patient information leaflet that comes with your medicine for the full list of possible side effects, or read more about the side effects of antihistamines.

What to do during an attack

During an attack, take your medication as soon as possible and grab the nearest available support. Get into a position in which you feel most stable or comfortable and keep as still as possible. If you need to move, do so slowly and carefully. Close your eyes or keep them fixed on objects in front of you, and do not turn your head quickly.

Once your symptoms start to improve, it’s best to gradually try to move around as this encourages your brain to use your vision and other senses to compensate for the problems in your inner ear.

Severe attacks

If you suffer severe vertigo, dizziness, nausea and vomiting during an attack of Ménière’s disease, you may need to be injected with prochlorperazine by your doctor.

If you suffer severe vertigo with or without nausea during an attack, your doctor may also prescribe you a tablet of Buccastem that dissolves very quickly in your mouth (see above).

In particularly severe cases, you may need to be admitted to hospital to receive intravenous fluids (through a vein) to keep you hydrated.

Preventing attacks

Your GP can prescribe a medication called betahistine to help reduce the frequency and severity of attacks of Ménière’s disease, or you may be advised to change your diet.

Special diets

Although it has not been proven to be consistently effective, following a diet without added salt can help some people control their symptoms. It is possible that this type of diet might alter the fluids in your inner ear.

Avoiding excessive caffeine, found in drinks such as tea and coffee, is also usually recommended.

Betahistine

It is thought that betahistine reduces the pressure of the fluid in your inner ear, relieving the symptoms of Ménière’s disease. Research that has been carried out into betahistines has not found enough evidence to confirm whether they are effective, but your GP may recommend trying them to see if they help.

Betahistines are usually available as tablets to be taken three times a day. Your GP will discuss how long you need to take them for, which could be a few weeks, or up to a year. Possible side effects include a headache, upset stomach and a rash.

Treating tinnitus

There are a number of different treatment options that can be used to treat tinnitus caused by Ménière’s disease. Some possibilities include:

• Sound therapy – the effects of tinnitus are often more pronounced in quiet environments. The aim of sound therapy is to fill the silence with neutral, often repetitive sounds to distract you from the sound of tinnitus.
• Relaxation techniques – tinnitus can be a distressing and intrusive condition. Relaxing by practising yoga or special breathing techniques may help you to avoid stress and anxiety.
• Cognitive behavioural therapy (CBT) – this is a therapy based on the knowledge that severe Ménière’s disease symptoms have a significant psychological effect, resulting in negative thoughts and behaviour, which in turn aggravates your symptoms and creates a vicious circle. CBT is given by a specially trained professional who aims to change the way you think and behave in order to break this cycle.

Read more about treating tinnitus.

Treating hearing loss

If your Ménière’s disease is in the middle or end stages, you may experience some permanent hearing loss. Ménière’s disease tends to make you more sensitive to loud sounds, and also makes it more difficult for you to distinguish low-pitched sounds.

There are a variety of hearing aids available that may be suitable for you. Hearing therapists and organisations, such as Action on Hearing Loss, can provide you with helpful advice for dealing with hearing loss.

Read more about treating hearing loss.

Vestibular rehabilitation

A physiotherapist can help improve your balance by teaching you vestibular rehabilitation techniques. These exercises teach you how to cope with the abnormal and disorientating signals coming from your inner ear. You are taught to use alternative signals from your eyes, ankles, legs and neck, to keep you balanced.

Physiotherapy is usually used in the middle or late stages of Ménière’s disease, after the severe attacks of vertigo have stopped but when balance problems may remain.

VRT is usually provided by a hearing specialist or physiotherapist. Your GP may be able to refer you for VRT, although it will depend on availability in your area.

In some cases, it may be possible to use VRT without specialist help. Research has shown that some people can improve their symptoms using self-help VRT booklets. However, you should discuss this with your doctor first. If it is likely to be useful, you can download a copy of these booklets from the Ménière’s Society.

Surgery

In severe cases, surgery can be performed to control the attacks of vertigo. However, surgical procedures are usually only used if other treatments have failed.

The type of surgery you have will depend on your symptoms, and whether both ears are affected. You could have:

• non-destructive surgery
• selectively destructive surgery
• destructive surgery

Non-destructive surgery

Non-destructive surgery may be used if your hearing in the affected ear is ‘socially adequate’ (you can hear sounds that are below 50 decibels). This type of surgery aims to change the progression of Ménière’s disease by reducing the severity and frequency of your symptoms.

Types of non-destructive surgery include:

• endolymphatic sac decompression – this can help reduce the pressure in your inner ear by increasing the drainage of the fluid of your inner ear, although evidence of its effectiveness for Ménière’s disease is limited
• inserting ventilation tubes (grommets) – these are inserted into your ear to reduce the changes in pressure that cause Ménière’s disease
• injecting steroid medication through the eardrum – this is a newer type of treatment and there is only limited evidence to suggest it is effective
• micropressure therapy – a newer type of treatment with little evidence regarding its safety and effectiveness – grommets are inserted into your ear and are attached to a small pressure generator for a few minutes, several times a day, to alter the pressure in the inner ear

The National Institute for Health and Care Excellence (NICE) has more information on micropressure therapy for Ménière’s disease.

Selectively destructive surgery

In selectively destructive surgery, the balance part of the inner ear is destroyed with a medicine called gentamicin. This is injected through the ear drum (the thin layer of tissue separating the outer ear from the middle ear) and enters the labyrinth (the system of tubes in the inner ear).

Gentamicin should mainly damage the balance part of your ear, but there is a risk it could it damage your hearing too.

Some surgeons prefer to apply the gentamicin directly to the inner ear during a minor operation. This means they can control the exact dose of gentamicin that enters your ear.

Destructive surgery

Destructive surgery may be considered if only one ear is affected by Ménière’s disease. The hearing in the affected ear must be considered to be ‘socially inadequate’ (you cannot hear enough to function in social situations). As an approximate guide, if you cannot hear sounds that are below 50 decibels, this may count as socially inadequate.

Destructive surgery is used to destroy the part of your inner ear that is causing your vertigo attacks. However, these operations can cause permanent hearing loss in the treated ear so will only be considered if you already have permanently reduced hearing in the affected ear.

Destructive surgery can be done by:

• destroying the balance part of your audio-vestibular nerve – the nerve that transmits sounds and balance information to the brain
• destroying part of your vestibular labyrinth (labyrinthectomy) – the system of tiny, fluid filled channels in the ear

After the surgery, your other ear will take over your hearing and balance functions.

Safety and effectiveness of surgery

There are very few clinical trials looking into the effectiveness of surgery for Ménière’s disease, which is why surgery is rarely considered. If your ENT specialist thinks you may benefit from having surgery, they will discuss the procedure and any risks in more detail with you. 

Support groups and charities

There are several support groups and charities that can provide you with useful information and advice about living with Ménière’s disease. They can also put you in touch with other people who have the condition so you can share experiences and provide support to one another.

See living with Ménière’s disease for more information.

Vertigo
Vertigo is the sensation that you or the environment around you is moving or spinning.

Tinnitus
Tinnitus is the medical name for the perception of noise in one ear, both ears or in the head. The noise comes from inside the body rather than an outside source.

Jan Dawson was diagnosed with Ménière’s disease a few years ago and lives with hearing loss and tinnitus. Thankfully, the high-pitched ringing in her ears doesn’t bother her that much because she’s had time to get used to it. She tells her story.

“It wasn’t long after I’d moved into a new, much quieter house in Edinburgh when I noticed a strange noise in my ear, a bit like a radio transmitter. It started off fairly quiet but then gradually got more noticeable. I was 27.

“It worried me because I’d also been hearing heartbeat-like noises in my other ear. I’d had that on and off since I was small. I went to my GP to get it checked out and was referred to an ear, nose and throat specialist. After some hearing tests I was diagnosed with Ménière’s disease, with symptoms of tinnitus and hearing loss.

“I thought, ‘Surely I’m too young to get tinnitus?’, and remember wondering how I was going to cope with this ringing in my ears for the rest of my life. It was really upsetting, as I was told there was no cure.

“During this time I had an attack of vertigo on holiday, which lasted for three days. It felt like the ground was constantly moving beneath me, like being on a ship. It didn’t make me physically sick but I felt queasy. Thankfully I’ve not had it since, unlike many other people with Ménière’s disease, who get this feeling a lot.

“As well as my tinnitus I have low-level hearing loss, which means I struggle to hear people, especially in meetings at work. I keep getting tested for hearing loss and it hasn’t got any worse, but I think the tinnitus might be getting louder. It’s there all the time in the background, but I notice it more when I’m stressed, when I think it gets a bit louder. It’s a high-pitched noise that changes randomly and sounds like someone trying to tune a radio.

“I’ve really got used to my tinnitus. It’s not so loud that it stops me hearing everything that’s going on. And when there’s lots of other background noise I don’t really hear it.

“I still go to clubs where there is loud music, but I wear a special set of earplugs to protect my hearing. I love listening to music on my iPod. When I play it with the volume low I drown out the tinnitus and get some relief.

“The hearing loss upsets me more than anything. But my employer has been fantastic and measures have been put in place to ensure I don’t miss important information in meetings. I get hard copies of the notes and am always seated near the speaker.

“I don’t take any treatments for tinnitus but I try not to get too stressed. I now have a 17-month-old daughter and was warned that the Ménière’s might worsen during pregnancy, but luckily this didn’t happen.

“Being positive is the key: if you let the condition get to you, like I did at the beginning, you start to think about it all the time and notice it a lot more. If you can learn to live with it then it makes life a lot easier.”